What happened to this patient? Should him be intubated?

[Bjorn Szabo]

Hi there. I'm sorry this isn't your ordinary professional post. In fact I'm looking for some help with a situation (sorry bad English).

My father (55) fell on the corridor, when I arrived (few seconds later) he had his arms stiff, pointed to the ceiling (and a bit towards his 'up'). I tried to reanimate him with typical measures like putting him in a sitting position, calling and shaking him and he started breathing, although heavily through saliva and moving his tongue and opening his eyes (not focused). I got the impression he was trying to say something. I thought he was coming back. I don't remember when he became "relaxed" (if before/after that), and I quickly started to carry him outside to call for help, when almost outside I noticed his tongue was obstructing his throat, and unfortunately I was in despair so I released him and he hit his head on the floor (from about 18 inches). With two fingers I could unblock his throat but his tongue would go back. At this point I couldn't hear his heart and he had pupils dilated. He also stopped breathing and I started CPR and he was exhaling spontaneously, I could feel a bump on his head what I guess suggests blood circulation. We put him in trunk of a truck and drove to the hospital. It took I believe around 10-15mins to arrive there and I was doing CPR as best as I could all the time. He stopped exhaling by himself on the way, I can't tell exactly when. He was however still normally hot.

I wonder two things:
1- What most likely happened? Heart attack? If so, was he already dead when he fell? (or maybe when he got relaxed) and the other signs like breathing and such were purely by reflex?
2- He wasn't intubated... I found this disturbing because he was alive like 30 min before, and was breathing few minutes before. I'm no expert but I had a clear impression that breathing was a big deal as he apparently was making a huge effort trying to breath. Does that 1.5hour only apply to minor heart attacks, and the sudden ones aren't even worth a try?

I feel extremely guilty for letting his head hit the ground and also perhaps doing something else wrong like wasting too much time... but I also feel that the hospital didn't do not even remotely everything they could to save him. They told me he arrived without pulse. I'm talking about a public hospital in a 3rd world country here (generally not good).

Thank you very much. You have no idea how important discussing that is to me.

Edited August 2, 2016 by Bjorn Szabo

[paramedicmike]

Hello, Bjorn.  My condolences to you regarding the death of your father.

From what you have written it sounds like your father suffered an out of hospital cardiac arrest.  There are many causes that can contribute to this.  Unfortunately, it is impossible for me or anyone else here to speculate as to the cause. 

Should your father have been intubated is another question that cannot be definitively answered.  Current evidence is mixed with some studies suggesting that intubating cardiac arrest victims leads to worse outcomes.  The hard part here is that you did not have any airway management equipment with you.  You were doing CPR in the back of a moving truck.

Approximately 90% of out of hospital cardiac arrests in the US die.  As you didn't share what country you're posting from I don't know the numbers that are relevant for you.  Many times, however, despite your best efforts, things end badly.  In this case you were unable to revive your father

From what you've posted you did everything you could to try to help him.  Take comfort in knowing that you did everything you could to help him. 

[Bjorn Szabo]

Thank you very much Mike. I'm feeling really bad because I let his head fall, I'm not sure to what extent that could have worsen his condition, I also didn't have the strength to take him faster to the truck. I don't know if it would be better to wait for an ambulance while doing CPR too... another thing that is really killing me inside is that I don't know until when he was conscious... I guess he could hear me when I arrived but after that I don't know. Is it normal for the patients to have the arms stiff like that in a cardiac arrest? Did you ever talk to someone who came back from something like that to know until when they were conscious?

Again, thank you very much. This is really important to me. I know words aren't much but you can be sure I'm really grateful.

[Just Plain Ruff]

Man Bjorn,  not a good situation and my condolences on your father's death.  

I'm not going to speculate as to whether you should have waited for an ambulance or driven him in yourself.  

What country did this occur in?  I would say I would have waited for the ambulance if it was a country with good EMS resources but if not, then probably the best response was what you did.  

As for not intubating your father, did they do any other type of airway, one that you didn't realize was an airway that would have taken the place of the E.T. tube?  There are others out there that some facilities with less resources might use.  

There are so many variables it's hard to tell in this case.

It's hard to play armchair quarterback at this time but if this was my father I'd want more answers but I'm not sure how I would go about getting them.  You might not be able to get those answers unless you file suit and you might not like the answers you get.  Or you might just be able to do a medical record review of his chart if possible.  not sure about that though.  

 

[Bjorn Szabo]

Thank you very much Ruffmeister.

I didn't wait the ambulance exactly because we had a very bad experience in the past in which the ambulance took too long to arrive, so I called it but wasn't counting on it, and since I got help from the truck driver soon after calling, I decided to just take him there instead, but maybe I could have talked to the person on the line, asked if it was going to take too long or something... i could even have asked if there was something else i could do to help him or if i was doing something wrong...

They didn't let me see him much, but I didn't see any tube or something... I asked if he was intubated and they said no.

When people suffer a cardiac arrest, do they stay conscious? I don't have contact with people who came back from one and Google didn't help me...

Also, is it normal for people to have the arms stiff like that?

Thank you very much.

 

EDIT: Also, if his heart was stopped, he wouldn't be able to breathe right? So the actual arrest (heart stopping) I'm guessing happened after that.

Edited August 3, 2016 by Bjorn Szabo

[Bjorn Szabo]

Can't edit the previous post...

I've been reading and he wasn't breathing normally. I see there are various patterns, I've read and watched a video on agonal respiration but it wasn't much like that. It was short inhalations and exhalations very randomly spaced but maybe it was agonal respiration and that difference was due the tongue and saliva, is that possible? If not, is there a name for that kind of very inconstant (or intermittent) breathing?

I read that while he was like that he was probably in agony.